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Objectives: This is a retrospective cohort analysis of diabetes and its associated factors from Electronic Medical Record (EMR) of 2020-2022 of Indus Hospital Health Network (IHHN), Korangi campus Karachi. Methods: Retrospective cohort study was conducted at Indus Hospital & Health Network (IHHN), Korangi Karachi. Out-patient records of adult patients of 2020-2022 were extracted from EMR of IHHN in March 2023. Descriptive statistics were presented as median (IQR) and frequency and percentage. Chi-square test determined association of risk-factors with diabetes and Wilcoxon-sign-rank test compared change in HbA1C from baseline. Results: Data of 460,799 adult patients were extracted and analyzed. Median age of patients was 38.71 (27.87-52) years. Female preponderance was observed in our study. Out of 460,799, HbA1C was seen in 42,638 (9.25%) patients. Among these 29,596 (69.4%) had a HbA1C = 6.5% while 13,042 (30.6%) had a HbA1C in the pre-diabetes range. Significant association was found between age, baseline creatinine, LDL and diabetes with no association depicted between gender, BMI, blood pressure, triglycerides, HDL and diabetes status. Patients in general had higher HbA1C at baseline as compared to last visit (p-value<0.001). Conclusion: High blood pressure, obesity, increased creatinine, micro albuminurea, high LDL and Triglycerides were important risk factors for diabetes. This study reports a snap shot of the status of diabetes and associated risk-factors in the Pakistani population. This was the first time that a large data was extracted and analyzed from a healthcare institution in Pakistan, which would guide physicians and public health practitioners to take evidence-based decisions for prevention and management of diabetes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the T2DM patients' reasons for refusing insulin therapy and their initial barriers to use insulin. Study Design: Cross-sectional Observational study. Setting: Primary Outpatient Health Care Center Karachi. Period: 15th October 2022 to 15th January 2023. Material & Methods: Total 800 diagnosed patients of type-II diabetes mellitus having HbA1c level about 7.0% were included in study, participants were interviewed and necessary data and their response against insulin was recorded on designed questionnaire. Results: Total 800 number of patients were enrolled in study, 434 were female (54.25%) while 366 were male (45.75%) participants. The average age of total patients was 45.6±10.5. Study reported that 28.5% patients mentioned that its painful procedure. 25% patients were unaware about insulin, 15% mentioned that it is difficult to self-inject, 10.5% lack of technical person or medical staff that can inject over there, 7.5% patients believe that insulin is last resort of treatment, 5% needle phobia, 4.5% reluctant due to un affordability of insulin, 3% insulin would be addictive, and 1% patients with religious restriction was reported. Conclusion: Study explore many reason that are mainly influencing use of exogenous insulin for the treatment of diabetes mellitus. Insulin therapy is painful procedure consideration have been recorded more common while other factors unawareness about insulin, needle phobia, lack of technical people in home specially in backward areas and insulin is last resort of treatment beliefs are also major important factors reported during study. [ABSTRACT FROM AUTHOR]

This study investigated the level of effective ethical leadership practices of primary school heads from the perspective of teachers serving in Karachi schools. It also compared the effective ethical leadership practiced by primary school head from the perspective of teachers serving in Karachi schools in terms of their various demographics including gender, academic qualification, professional qualification, and locality of their schools. Using a quantitative exploratory method, it targeted the primary schools in each district of Karachi to approach the teachers currently serving in the respective primary schools. The findings of the study revealed that teachers perceive the effective ethical leadership practiced by primary school heads. However, this perception of teachers changed frequently based on their different demographic characteristics that led the study to infer a potential biasness displayed by the primary school heads while practicing their leadership. The study recommends awareness sessions and training programs for primary school heads to avoid their potential biasness. [ABSTRACT FROM AUTHOR]

Background and Objective: Unceasing rise in cases of enteric fever, in particular extensively drug resistant (XDR) strain of Salmonella enterica, has led to a growing threat, leaving only carbapenems and azithromycin as the precious option. In this regard, we determined the burden and clinical course of XDR salmonella in comparison to multidrug-resistant (MDR) and drug sensitive (DS) strains. Methods: A retrospective chart review of 1515 Salmonella Typhi (S.typhi) culture positive patients was conducted at Indus Hospital and Health Network, Karachi from July 2017 to December 2018. Results: During our study, we observed children at the age of 5-6 years and adults at the age of 20-22 years were the chief targets of S.typhi. Further, we witnessed a rapid shift of drug resistance from MDR to XDR over the one year of study. Almost all patients presented with fever. However other signs and symptoms like malaise, body aches, anorexia, diarrhea, vomiting and abdominal pain were more common in XDR Typhoid patients. Further, the need of hospitalization, total hospital stay and mortality was also greater for XDR typhoid patients. Conclusion: There is a crucial requirement for consolidated steps to curtail the spread of XDR Salmonella tyhi disease as its management is challenging, and it is associated with increased morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objective: To assess the early benefit and usefulness of platelet count to diameter of spleen ratio as a non-invasive parametric tool in detection of esophageal Varices in liver cirrhosis. Study Design: Prospective observational study. Place and Duration: Department of Medicine, Hamdard University Hospital, Karachi from February 06, 2019 to August 31, 2019. Methodology: Among cirrhotic patients, ultrasound technique was employed for platelet count and spleen bipolar ratio. The patients were also screened for esophageal varices. Patients who had active bleeding from upper gastro-intestinal tract were excluded from study. Ratio of Platelet count to diameter of spleen was determined and estimated for all subjects and analyzed. Results: Among 85 liver cirrhotics, 68.2% were male and esophageal varices were found in 63.5% patients. The cut-off value for ratio of platelet count to spleen diameter was 1014 with 76% sensitivity and 67.1% specificity. Among all, 83.33% was estimated by positive predictive value and 80.65% by negative predictive value. The diagnostic accuracy was 82.35%. Conclusion: There is noticeable advantage and usefulness in early detection and advance prediction of esophageal varices in liver cirrhotic subjects by employing non-invasive method of ratio of platelet count to spleen diameter. [ABSTRACT FROM AUTHOR]

Introduction: Posterior fossa brain tumor is the most devastating forms of human illness, primarily because of the limited space within the posterior fossa, the potential involvement of vital brain stem nuclei, and the mass effect causes obstructive hydrocephalus. Posterior fossa tumors are more common in children than adults. The Objective of the Study: To find out the satisfactory surgical outcome of posterior fossa brain tumors in children at Civil hospital, Karachi. Materials and Methods and Duration of Study Setting: This prospective observational, case series study was conducted from February 2015 to February 2105 in the Department of neurosurgery, Dow University of Health Sciences, Civil Hospital, Karachi, Karachi. Postoperative patients with the diagnosis of posterior fossa tumor were enrolled in the study. Detailed history, physical examination, anthropometrics, and biochemical measurements were recorded. Magnetic resonance imaging was done to determine the satisfactory surgical outcome. Patients were followed up at the third postoperative month to determine the satisfactory surgical outcome. Results: Seventy-one patients fulfilling the inclusion criteria, the mean ± standard deviation age of the study population was 6.63 ± 3.181 years. 29 (40.8%) were <7 years of age and 42 (59.2%) were of age 7 years and above. 50 (70.4%) were males and 21 (29.6%) were females. 49 (69%) patients presented with vomiting. 34 (47.9%) presented with seizures. (40.8%) had papilledema. (25.4%) presented with hemiparesis. 8 (11.3%) had meningismus. On analysis of the frequency of outcome variables (80.3%) achieved the satisfactory surgical outcome. Conclusions: There has been no major study to determine satisfactory surgical outcome in postoperative patients with posterior fossa brain tumor in our population. The study was to provide local data in our population and compare it to the international data. This may help in proper patient management. Majority of the patients had satisfactory surgical outcome. The absence of papilledema, hemiparesis, and meningismus had more chances of satisfactory surgical outcome. [ABSTRACT FROM AUTHOR]

Brucellosis is a zoonotic disease which affects humans, farm animals and wildlife as well. In Pakistan, the status of human and farm animal brucellosis is documented but the information about brucellosis in wildlife is lacking. To access the seroprevalence of Brucella antibodies in avian (turkeys, peafowl, guineafowl, mallard ducks and Indian blue rock pigeon) and selected wild species (reptiles and amphibians), a total of 117 serum samples (reptile = 34, amphibian = 04, avian n = 79) were collected from Karachi and Pattoki regions of Pakistan. Serum samples were screened for Brucella antibodies using Rose Bengal plate test (RBPT) and 11.1% serum samples were found positive. Overall, 2.5% birds, 29.4% reptiles and 25% amphibians were seropositive for Brucella antibodies. This is first report of detection of Brucella antibodies in reptiles and amphibians in Pakistan. [ABSTRACT FROM AUTHOR]

Objectives: Our study aims to determine the frequency of progressive hemorrhagic injury as observed on the CT scan from the initial scan performed at the time of presentation to a subsequent one in the 12 hours after the initial scan. Study Design: The type of study is a prospective observational case series. Setting: At Tertiary Care Hospital in Karachi, Pakistan. Period: 3 months from June 2018 to August 2018. Materials & Methods: All patients over 18 years of age who presented to the Accident and Emergency Department of the hospital with traumatic brain injury and had a CT scan performed within four hours of the injury were included in the study. A predesigned proforma was used to note down patient findings. CT scan findings were classified as subdural hematoma (SDH), intraparenchymal contusion (IPC) extradural hematoma (EDH) and subarachnoid hemorrhage (SAH). A repeat CT scan was performed twelve hours after the initial CT scan. Data were analyzed using IBM SPSS version 20.0, mean and frequencies were calculated for continuous variables while frequencies and percentages were calculated for categorical variables. Results: Of the n= 110 patients in our study 79 were males and 31 were female, the mean age of the patients was 34.25 years. The Glasgow Coma Scale scores at the time of arrival were between thirteen and fifteen for n= 33 (30%) of the patients, between nine and twelve for n= 54 (49.09%) of the patients, less than and equal to eight for n= 23 (20.90%) of the patients. Subarachnoid hemorrhage was present in n= 32 (29.09%) patients, intraparenchymal hematoma was present in n= 42 (38.18%) of the patients, while subdural hematoma and epidural hematoma was present in n= 14 (12.72%) and n= 22 (20%) of the patients respectively. Progressive hemorrhagic injury was found in n= 66 (60%) of the patients, while in n= 11 (10%) of the patients there was resolution of the lesion and n= 33 (33%) of the patients showed no observable changes in the repeat CT scan. Finally, our results indicate that of the 110 patients in our study PHI was seen in n= 17 (53.12%) patients with SAH, n= 18 (81.81%) patients of EDH, n= 5 (35.71%) patients of SDH and n= 26 (61.90%) patients of IPC respectively. Conclusion: According to the results of our study PHI is observed in 60% of the patients with a traumatic brain injury observed within the initial 12 hours after injury, and epidural hematoma and intraparenchymal contusions had the highest incidences of PHI among all the different types of traumatic brain injuries. [ABSTRACT FROM AUTHOR]

Objective: To reassess the reasons for blood donor deferrals as per donor history questionnaire and physical examination findings. Study Design: Cross-sectional study. Place and Duration of Study: Blood Bank, Dr. Ziauddin Hospital, Karachi Pakistan, from Jan 2017 to Dec 2020. Methodology: After approval from the Ethical Review Committee, all donors reporting at the blood bank were included. All donors were interrogated via a detailed donor health questionnaire. Data for donor history and physical examination findings were retrieved from the Blood Bank Information Software System (BBIS). Results: During the study period, 33,095 donors reported at the. Blood Bank. Of the total donors, 25,531(77.1%) were accepted and donated blood, while 7564(22.9%) were deferred for different reasons. The majority of donations were from males (32773,99.0%), and female donations accounted for 1%, while females accounted for more deferrals as compared to males. Most deferrals were due to low Hemoglobin (2722,36%), followed by injection/needle stick injuries (1994,26.4%). Less common causes observed were donors not feeling fit for donations, medications, etc. Conclusion: In our study, the deferral rate was 22.9%, with low haemoglobin being the most common cause, followed by injections/needle stick injuries. [ABSTRACT FROM AUTHOR]

Aims: The purpose of our study is to evaluate the surgical outcome in patients undergoing anterior cervical corpectomy without fixation with plates and screws for the treatment of ossification of posterior longitudinal ligament (OPLL). Subjects and Methods: The type of study was case series and was conducted from January 2015 to December 2015 for 1-year duration at the Department of Neurosurgery at a Tertiary Care hospital in Karachi, Pakistan. A total of n = 20 patients (16 men and 4 women; mean age of 57.45 ± 6.4 years [range: 45–68 years]) were included after thorough clinical history and physical examination. Neurological evaluation was done using the Japanese Orthopedic Association (JOA) scoring system. The pre- and post-operative JOA scores were used to calculate recovery rate (RR) of the patients. Radiographic assessment was done using various modalities such as X-ray, computed tomography scan, and magnetic resonance imaging. Surgical outcome and complications were studied and the data were analyzed using SPSS 21. Results: After the uniform follow-up period of 12 months, mean JOA scores improved from 9.1 ± 1.37 preoperatively to 14.3 ± 1.69 postoperatively and mean RR was 67.01 ± 15.5%. All the patients showed successful osseous fusion while one patient did not. Two patients developed cerebrospinal fluid leakage, one patient developed recurrent laryngeal nerve palsy, and one expired due to iatrogenic neurological deterioration. Conclusion: Anterior cervical corpectomy without fi xation with plates and screws is an effective surgical procedure for the treatment of OPLL (for up to three cervical levels of OPLL). It gives good neurological recovery with fewer postoperative complications. [ABSTRACT FROM AUTHOR]

Diabetes is a very prevalent problem in Pakistan. Depression along with diabetes affects not only quality of life but compliance and management of patient. Various studies have found high prevalence of depression among T2DM depression. In our study we shall determine the prevalence of depression among T2DM patients in Pakistan. The objective of this study was to find out the prevalence of depression in Type2 diabetes mellitus patients. Study Design: Cross-sectional study. Setting: Jinnah Post Graduate Medical Centre Karachi. Period: May 2017 to December 2017. Materials and Methods: The patients with a diagnosis of type 2 diabetes above age 30 years (Male= 50 (30.1%) Female=116 (69.9%) Total=66 Patients), were recruited after informed consent. Type 2 diabetes mellitus patients both male and female above age 30 were included in the study. Results: Mean PHQ- Score is 10.83±5.6. 81.9% had PHQ Score > 4. According to PHQ-9 scale, 18.1% (n=30) had no depression, 26.5% (n=44) had moderately severe depression and 3.6% (n=6) had severe depression. In our study females had more severe depression in comparison with male (5.2% vs. 0%). Conclusion: Depression is very common in Pakistan among Type 2 Diabetic patients. Antidepressant has key role to break the vicious cycle of depression and type2 diabetes mellitus diabetes. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim of this study was to determine the frequency of headache disorders in undergraduate medical students of Karachi, Pakistan and determination of various associating factors. METHODS: This was a descriptive cross- sectional study including 402 participants. All were medical students from first year to final year enrolled at two medical colleges of Karachi, Pakistan. The ethical approval of study was obtained from Dow University of Health Sciences. The students were inquired about the occurrence of headaches during the past one year and various triggering and risk factors. RESULTS: Headaches were experienced by 87.8% students (N=353; females=249). Of these, 17.8% were found to have migraine, 75.3% had tension-type headache (TTH), 4.0% had both migraine and TTH and 2.3% suffered from cluster headaches. A quarter of students suffering from headache were found to have a positive family history, while stress, fatigue, sleep disturbance and nasal congestion were the most commonly reported trigger factors. More than half (60%) students stated that they did not take any medications for headaches. CONCLUSION: This study found a very high frequency of headache among medical students of Karachi, Pakistan. A number of trigger factors were identified which if curtailed may reduce the occurrence of headache. [ABSTRACT FROM AUTHOR]

Solar energy is a potential source for a thermal power generation system. A direct vapor generation solar organic Rankine cycle system using phase change material storage was analyzed in the present study. The overall system consisted of an arrangement of evacuated flat plate collectors, a phase-change-material-based thermal storage tank, a turbine, a water-cooled condenser, and an organic fluid pump. The MATLAB programming environment was used to develop the thermodynamic model of the whole system. The thermal storage tank was modeled using the finite difference method and the results were validated against experimental work carried out in the past. The hourly weather data of Karachi, Pakistan, was used to carry out the dynamic simulation of the system on a weekly, monthly, and annual basis. The impact of phase change material storage on the enhancement of the overall system performance during the charging and discharging modes was also evaluated. The annual organic Rankine cycle efficiency, system efficiency, and net power output were observed to be 12.16%, 9.38%, and 26.8 kW, respectively. The spring and autumn seasons showed better performance of the phase change material storage system compared to the summer and winter seasons. The rise in working fluid temperature, the fall in phase change material temperature, and the amount of heat stored by the thermal storage were found to be at a maximum in September, while their values became a minimum in February. [ABSTRACT FROM AUTHOR]